Adding modifiers to claims and superbills

Some insurance payers require modifiers for accurate claim or superbill submission. This guide outlines how to enable, add, and manage modifiers throughout your workflow.

In this guide, we’ll cover:

• Enabling modifiers in your account
• Adding modifiers to individual appointments
• Setting a default modifier for a client
• Using modifiers in the SimplePractice mobile app
• Updating a claim or superbill to include a modifier
• Using modifiers for Telehealth appointments

Note: Modifier requirements vary by insurance payer. We recommend reaching out to your payer(s) to confirm their requirements before submitting claims.

Enabling modifiers in your account

To enable modifiers in your account:

1. Navigate to Settings > Client billing and insurance > Insurance documents
2. Check the box next to Enable Modifiers for your practice

3. Click Save changes

Adding modifiers to individual appointments

You can add modifiers to specific appointments from your calendar or from a client’s Billing page. This is recommended when a modifier is needed only occasionally.

Note: Adding a modifier to an appointment before creating a claim or superbill will include it automatically. To update a modifier on a document after it’s created, see Updating a claim or superbill to include a modifier.

Adding a modifier from your calendar

1. Click the appointment
2. Enter the modifier in the field below the service
3. Click Done

Note: You can add up to 4 modifiers per service code.

If the appointment is part of a recurring series, you’ll have the option to apply the modifier to all future appointments in the series.

Adding a modifier from a client’s Billing page

1. Navigate to the client’s Billing page
2. Click Manage > Edit details next to the appointment

3. Add the modifier in the field under the appointment details

4. Click Save

Important: Adding a modifier to an appointment won’t apply it to an existing claim or superbill. See Updating a claim or superbill to include a modifier for instructions.

Setting a default modifier for a client

You can set a default service code and modifier for a client so all future appointments include that modifier automatically. You can still edit individual appointments as needed.

To add a modifier to a default service code:

1. Navigate to the client’s Overview page
2. Click Edit > Billing and Insurance
3. Scroll to Client Default Services and select a default Service Code
4. Enter the modifier(s) in the Modifiers field

5. Click Save Client

Using modifiers in the SimplePractice mobile app

You can add modifiers to appointments from the calendar in all versions of the SimplePractice mobile app, as long as modifiers are enabled for your practice through the web app.

iOS

1. Navigate to the calendar
2. Select an appointment
3. Tap Edit
4. Select Services > Modifiers
5. Enter your modifier(s)

6. Select the back arrow twice
7. Tap Save

Android

1. Navigate to the calendar and select an appointment
2. Tap the pencil icon
3. Select Billing > Modifiers
4. Enter your modifier(s)
5. Tap the checkmark
6. Tap the checkmark again to save all changes

Note: For more information, see Getting started with the mobile app for iPhone/iPad and Getting started with the mobile app for Android.

Updating a claim or superbill to include a modifier

If a modifier is added to an appointment after a claim is created, it won’t automatically appear on the claim. To update the claim:

1. Click Edit at the top of the claim
2. Enter the modifier in box 24d
3. Click Save

You can also delete the existing claim and recreate it so the modifier appears automatically.

Important: If a claim was denied due to an incorrect or missing modifier, see What to do when a claim is denied.

If a superbill has already been created, a modifier can’t be added retroactively to the appointment or the superbill. To update the superbill:

1. Delete the existing superbill
   • If you’d like to keep a record, download it as a PDF
     • For more information, see Creating a superbill.
2. Add a modifier to the individual appointment(s)
3. Create a new superbill

The modifier will appear in the Service column:

Using modifiers for Telehealth appointments

The following modifiers are typically used for Telehealth billing:

• If you're billing a commercial insurance payer, use 95
• If you're billing Medicare, use GT

You can assign one of these modifiers to your Telehealth location so it automatically populates on claims or superbills:

1. Navigate to Settings > Practice > Practice details
2. Click Edit next to your Telehealth location

3. Open the Telehealth modifier dropdown

4. Choose 95 or GT
   • If you don’t want a default modifier, choose None
5. Click Save

You can assign a modifier, or none, for each office location you’ve added.

Note: If a client’s default service code includes a modifier, it’ll override the location’s default modifier.

Requirements vary by insurance payer. We recommend contacting the payer directly if a claim is denied for an incorrect modifier or if you're unsure which modifier to use.